Osteoarthritis (OA) is a highly prevalent joint disease still lacking effective treatments. Its multifactorial etiology hampers the development of relevant preclinical models to evaluate innovative therapeutic solutions. In the last decade, the potential of Mesenchymal Stem Cell (MSC) secretome, or conditioned medium (CM), has emerged as an alternative to cell therapy. Here, we investigated the effects of the CM from adipose MSCs (ASCs), accounting for both soluble factors and extracellular vesicles, on human osteochondral explants. Biopsies, isolated from total knee replacement surgery, were cultured without additional treatment or with the CM from 10⁶ ASCs, both in the absence and in the presence of 10 ng/mL TNFα. Tissue viability and several OA-related hallmarks were monitored at 1, 3 and 6 days. Specimen viability was maintained over culture. After 3 days, TNFα induced the enhancement of matrix metalloproteinase activity and glycosaminoglycan release, both efficiently counteracted by CM. The screening of inflammatory lipids, proteases and cytokines outlined interesting modulations, driving the attention to new players in the OA process. Here, we confirmed the promising beneficial action of ASC secretome in the OA context and profiled several bioactive factors involved in its progression, in the perspective of accelerating an answer to its unmet clinical needs.

Background/Objectives: Radial head arthroplasty is a commonly preferred treatment for complex, unreconstructable radial head fractures. Recent studies have raised the question of whether factors such as bone resorption may be related to failure. This observational, retrospective, multicenter, spontaneous, and non-profit study aims to assess radiological outcomes, focusing on bone resorption around the stem, for radial head replacement using a modular, cementless radial head prosthesis with interconnected porosity. Methods: A series of 42 cases was available for review. Patients underwent radial head arthroplasty using a three-dimensional-printed radial head prosthesis. Patients were eligible for inclusion if they had undergone at least one follow-up between 6 and 15 months post-operatively. A scoring system to detect bone resorption was developed and administered by two independent evaluators. Results: Forty-two patients (14 males, 28 females), with an average age of 59 ± 11 years (range: 39–80 years), were analyzed with a minimum of six months’ and a maximum of 32 months’ follow-up. At follow-up, 50 radiological evaluations were collected, with 29 showing ≤3 mm and 12 showing 3–6 mm resorption around the stem. The average resorption was 3.5 mm ± 2.3. No correlation was found between the extent of resorption and the time of follow-up. The developed scoring system allowed for a high level of correlation between the evaluators’ measurements of bone resorption. Conclusions: Radial head prosthesis with interconnected porosity provided a low stem resorption rate for patients after a radial head fracture at short-to-mid-term follow-up after the definition of a reliable and easy-to-use radiological-based classification approach. (Level of Evidence: Level IV).

Lateral elbow pain is a common condition often misattributed solely to tendinopathy, while subtle instability may represent a significant underlying cause. Traditional classifications of elbow instability primarily address traumatic or grossly unstable patterns, leaving minor forms underrecognized. Recent evidence has emphasized the role of the Radial-Lateral Collateral Ligament (R-LCL) in maintaining joint stability, and its elongation has been linked to Symptomatic Minor Instability of the Lateral Elbow (SMILE). This model describes a horizontal type of radiocapitellar instability, where ligamentous incompetence leads to compensatory overload of the extensor carpi radialis brevis, ultimately producing chronic pain. Advances in diagnostic tools—including dynamic ultrasound (HELP-US test), CT arthrography with the SMILE Index, and arthroscopic signs such as the Loose Collar Sign—have improved recognition of this condition. However, surgical controversies remain, particularly regarding the potential destabilizing role of lateral release in patients with unrecognized R-LCL pathology. Arthroscopic stabilization techniques, such as R-LCL plication or imbrication, have shown promising outcomes, offering pain relief and functional recovery with minimally invasive approaches. This review integrates anatomical, biomechanical, and clinical evidence into a structured diagnostic and therapeutic algorithm, aiming to reduce diagnostic uncertainty and guide tailored interventions. Recognition of microinstability, and, in particular, the SMILE model, is crucial to optimize management of patients with chronic lateral elbow pain refractory to conservative measures.